MEDICARE: REPUBLIC HEALTH SPECIALISTS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	M2682	TX
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	L8186	TX
3	207VX0000X	Obstetrics Physician	M9610	TX

General Provider Information

NPI Number	:	1699182667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REPUBLIC HEALTH SPECIALISTS, PLLC

Provider Business Mailing Address
First Line	:	10740 N CENTRAL EXPY STE 275
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-2166
Country	:	US
Telephone Number	:	214-378-4661
Fax Number	:	888-624-8659

Provider Business Practice Location Address
First Line	:	1411 N BECKLEY AVE STE 152
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75203-1586
Country	:	US
Telephone Number	:	214-378-4661
Fax Number	:	888-624-8659

Authorized Official
Title or Position	:	CREDENTIALLING ASSOCIATE
Name	:	MISS BRANDY BARROW
Credential	:
Telephone Number	:	214-378-4661

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	04/07/2015

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